Patient-Identified Factors Related to Heart Failure Readmissions

Study Questions:

What are the patient-identified factors for readmission after hospitalization for heart failure (HF), and how do these correlate with medical record data?

Methods:

The authors conducted a qualitative study using 30- and 60-minute in-depth semi-structured open-ended patient interviews (n = 28). Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 months were eligible for the study. A detailed chart review was also conducted from the date of the index HF admission through the discharge date of the readmission.

Results:

Five themes emerged as reasons cited for hospital readmission: distressing symptoms, unavoidable progression of illness (including that of chronic comorbidities), influence of economic and psychosocial factors, good but imperfect self-care adherence (eating outside the home was cited as the primary reason for nonadherent behavior), and health system failures. Eight patients indicated that the readmission was preventable, and six believed that it was unavoidable. Approximately one third of patients said that they had been discharged prematurely from their index hospitalization. Thirteen of the patient interviews and medical record data were concordant in terms of the reason for readmission.

Conclusions:

The authors concluded that patient-identified factors for readmission after hospitalization for HF are highly heterogeneous, and may suggest that some readmissions are not necessarily preventable.

Perspective:

Even though HF accounts for the leading cause of hospitalization and readmission among older adults, we know relatively little about factors that contribute to HF readmissions. Few studies have incorporated the patient’s perspectives about causes for readmissions. Although limited by a small sample size and a qualitative study design, the present study highlights the heterogeneity of patient-identified factors that may impact readmission after hospitalization. Such factors warrant further exploration, and should be incorporated into future interventions designed to reduce HF readmissions.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Patient Readmission, Heart Failure, Hospitalization


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